Tarsal Tunnel Syndrome

What is tarsal tunnel syndrome?

Tarsal tunnel syndrome (TTS) is a condition that occurs when you have a damaged or compressed tibial nerve. The tibial nerve is a nerve in your ankle. It runs through your tarsal tunnel, a passage in your ankle made up of bones and ligaments.

People who have TTS may have pain, tingling, numbness or weakness in their feet. You might develop TTS because of overuse of your foot and ankle. You’re more likely to develop TTS if you exercise strenuously or frequently, especially if you have a very flat foot.

How common is tarsal tunnel syndrome?

Experts don’t know exactly how many people have tarsal tunnel syndrome. Many people who have TTS don’t get a formal diagnosis. TTS can affect people of all ages.

What causes tarsal tunnel syndrome?

Tarsal tunnel syndrome occurs when something damages your tibial nerve. Causes of tibial nerve damage can include:

• Flat feet.
• High arches.
• Injuries, such as an ankle sprain or fracture.
• Irregular growths, such as ganglion cysts, bone spurs or varicose veins.
• Masses such as lipomas or tumors near your tibial nerve.
• Body-wide (systemic) conditions, such as hypothyroidism, diabetes or arthritis.

For many people who develop tarsal tunnel syndrome, TTS is part of an overuse injury. More than 2 in 5 people with tarsal tunnel syndrome have a history of injuries such as ankle sprains. A sprained ankle is an injury to your ankle ligaments.

What are the symptoms of tarsal tunnel syndrome?

Tarsal tunnel syndrome causes signs of nerve pain. TTS usually causes pain in the inside of your ankle or the bottom of your feet. You may also experience:

• Burning sensations.
• Numbness.
• Tingling or “pins and needles” sensations.
• Weakness in your foot muscles.

Often, symptoms worsen during or after physical activity. If TTS is severe or long-lasting, you may experience symptoms all the time.

How do you test for tarsal tunnel syndrome?

To diagnose tarsal tunnel syndrome, your healthcare provider will ask you to describe your symptoms. They may examine your ankle or look for injuries, as well.

Your healthcare provider may also use:

• Tinel’s test: Your healthcare provider gently taps your tibial nerve. If you experience pain or tingling that reproduce your symptoms, it may point to TTS.
• Electromyogram (EMG): This two-part test uses an electrical impulse to measure your nerve and muscle function.
• MRI: MRIs use magnets and radio waves to take detailed images of soft tissue and bones inside of your body. Your healthcare provider may order an MRI to evaluate an injury or nerve damage or a mass putting pressure on your tibial nerve.

How do you treat tarsal tunnel syndrome?

Many people can manage tarsal tunnel syndrome symptoms with at-home or over-the-counter treatments. You might try:

• Rest: Staying off of your foot for a few days or weeks can promote healing and prevent further injury.
• Ice: Use ice packs for up to 20 minutes, a few times a day. Icing your foot can reduce swelling and pain.
• Compression and elevation: You may wear a supportive elastic bandage or brace around your ankle. Elevating your foot above your heart whenever possible can reduce inflammation.
• Nonsteroidal anti-inflammatory medications (NSAIDs): Over-the-counter NSAIDs such as ibuprofen (Advil®, Motrin®) may decrease pain and inflammation.

Your healthcare provider may also recommend nonsurgical treatments such as:

• Braces, casts or splints: A cast or splint keeps your foot in place to encourage nerve healing. If you have flat feet or severe symptoms, your healthcare provider may recommend a brace to reduce pressure on your feet.
• Orthotics: You may use custom-made shoe inserts (orthotics). Orthotics can help your foot maintain a proper arch. This position reduces the movements that cause nerve compression. A stability or motion-controlled shoe also keeps your foot from rolling inward (pronation) and reduces tension on your nerve.
• Physical therapy: A physical therapist prescribes exercises and stretches to improve your strength and range of motion.
• Steroid injections: Your healthcare provider may prescribe oral steroids or steroid injections to reduce pain and inflammation.

Do I need surgery for tarsal tunnel syndrome?

If TTS symptoms are still severe after trying nonsurgical treatments, your healthcare provider might recommend surgery. Operations are available that can release your tibial nerve or widen your tarsal tunnel. If a mass is putting pressure on your nerve, your surgeon will remove it.

How can I prevent tarsal tunnel syndrome?

There’s no guaranteed way to prevent tarsal tunnel syndrome. You can lower your risk of developing TTS if you:

• Rest between workouts to avoid overuse injuries.
• Stretch your feet and ankles regularly.
• Warm up before exercise.
• Wear proper-fitting, supportive footwear.

How long does tarsal tunnel syndrome last?

Sometimes, symptoms go away after you treat the underlying cause of TTS. For example, if you have a bone spur or lipoma, symptoms may disappear after treatment.

Often, people manage TTS symptoms long-term. TTS is less likely to go away entirely if you have a chronic condition such as arthritis.

Are there long-term effects from tarsal tunnel syndrome?

Without treatment, TTS can lead to nerve damage. If you develop nerve damage, it can be permanent and irreversible. You may have difficulty walking, exercising or performing your daily activities.

Thankfully, treatment can help you manage TTS symptoms. For the best results, it’s important to get treatment as soon as you start experiencing symptoms. Depending on the cause of TTS, treatment may even cure the condition.

What else should I ask my doctor?

You may want to ask your healthcare provider:

• What is the most likely cause of tarsal tunnel syndrome?
• Can at-home exercises reduce foot pain?
• What are the treatment options for TTS?
• When should I consider surgery for tarsal tunnel syndrome?
• How can I lower the chances that TTS symptoms will return after treatment?

What conditions are similar to tarsal tunnel syndrome?

Some foot conditions have symptoms that are similar to TTS symptoms. A healthcare provider can offer an accurate diagnosis and treatment. These conditions include:

• Bursitis.
• Compartment syndrome.
• Plantar fasciitis.
• Tendinitis.

A note from Cleveland Clinic

Tarsal tunnel syndrome is a condition that affects your foot and ankle. It occurs when your tibial nerve is damaged. Often, people develop TTS after overuse injuries. For many, nonsurgical treatment brings relief from tarsal tunnel syndrome. Your healthcare provider may recommend medications, steroid injections or custom orthotics. In severe cases, treatment might include surgery.